Why Care About Quality?

For doctors and hospitals, delivering cancer treatment is complicated.

Treating a patient with cancer is not like following a simple recipe, where mixing the same ingredients in any kitchen gives the same results. Cancer care is much more complex. It requires decisions from numerous professionals, dispensing treatments that are potentially life-saving, but also potentially dangerous and life-threatening.

The chances of cure and survival for any given patient depend on the expertise of the cancer team, and whether procedures are in place to ensure that cancer care is delivered properly.

A Patient's Story

A young woman, still in her early 40's, sat waiting in her surgeon's office. She was a single mother of two children and was meeting with her surgeon to find out if she had cancer.A suspicious spot had been found in her left breast. She'd already had a biopsy, meaning that a sample of tissue was taken from that spot to be examined under the microscope. A doctor called a pathologist had looked at the sample and written a report.Her surgeon came in the room to give her the news. It was cancer.

Her surgery was scheduled - a mastectomy. A mastectomy is a big operation. It includes removal of the whole breast and some lymph nodes in the armpit, leaving ribs and muscles behind, with only a scar where her breast used to be.But the report from the pathologist was written in a confusing way. The top of the report suggested that it was cancer, but the very bottom of the report said it was actually not. The surgeon gave the wrong news. And no one figured it out until after the mastectomy was done. The mastectomy was for nothing.

Big Stuff and Small Stuff

Big medical mistakes, like the story above, often make headlines. In 2015, a doctor in Michigan was stripped of his license and sentenced to decades in jail for giving chemotherapy to patients who didn’t even have cancer. Cancer centers in Minnesota, New York, Philadelphia, and others, gave the wrong doses of radiation. These big mistakes can result in serious harm.

But smaller errors, the ones that more easily fly under the radar and might not make headlines, can also have a major impact. A forgotten test result, an incorrect dose of a drug, or a treatment recommendation that goes against currently accepted guidelines, all of these can have serious consequences.

Quality is More Than Avoiding Mistakes

Quality means more than just avoiding mistakes. It means having the right processes in place to make sure all the right steps are taken, every time. Sometimes, in the rush to get treatment started, important steps are skipped. Studies show that many patients with lung cancer do not receive the recommended tests to determine the extent of cancer prior to starting treatment. If doctors haven't done all the recommended tests, they might miss important findings that would change the treatment recommendation.

For other patients, the opposite is happening. For women with early breast cancer, or men with low-risk prostate cancer, patients are being over-scanned before treatment. Looking for cancer in places where it's not likely to be found wastes time and money, and delays treatment. Even worse, these scans can have false positives - red herrings that require even more tests to prove that there is no spread of cancer.

Studies also show that doctors can be biased, favoring treatments that they themselves deliver. A surgeon is more likely to view surgery favorably, while a radiation doctor sees radiation in a more positive light. How is a patient supposed to get unbiased information?

High-quality cancer centers use many tools to help them catch mistakes, to make sure all processes are being followed, and to ensure that patients are getting good, unbiased treatment recommendations. Every patient should have these tools available for them.

How Important is Quality?

The numbers are dramatic. For a patient undergoing cancer surgery, the risk of dying from surgery can be reduced substantially – in some cases, reduced by more than half – depending on the choice of surgeon and hospital. For a patient undergoing radiation, the risk of dying from cancer or treatment can be reduced substantially with similar choices. These differences are well-studied, and known to doctors and researchers, but this information has not reached the public.

Why This Website?

For the most part, patients have no idea that the quality of their treatment is a key factor that can influence their survival. Making matters worse, even if patients became aware of this issue, they don’t have the tools to evaluate whether their team is providing top-notch care.

Many organizations are dedicated to improving the quality of patient care, and they have made several improvements. But these improvements are mostly directed at the institutional level, and change at that level can be difficult.

There is a better way. If we can educate patients about the importance of quality in cancer treatment, patients themselves will begin to demand the best possible treatments. And if patients demand it, doctors and hospitals will provide it. This will lead to change faster than any top-down approach.